Job Description

Summary: Responsible to develop, plan, organize and implement current and future strategies to bill customers, process payments, minimize bad debt, improve cash flow and manage the overall health of the company's receivables. Also responsible for managing the day-to-day activities of the Health Center as they relate to revenue cycle functions which include but are not limited to front office services, billing, collections, accounts receivables and financial planning for patients.

This position will work on revenue cycle performance to meet short and long term strategic goals and will provide analytical analysis and create written guidelines, policies, and procedures in accordance with implementation of all work processes as a result of thorough analysis.

Duties and Responsibilities

• Serve as the primary contact between the billing agency and the clinical staff.

• Manage the day to day billing operations within the Department with special emphasis on the front end systems to assure that all information provided to billing company is accurate and timely across all divisions and locations. This may include registration, scheduling, referral management, co-pay collection, self-pay collection, systems set up and issues.

• Responsible for denial work file management, collaborating with divisional managers and staff to ensure claims processing occurs in a timely manner. Coordinates edit code training for front end staff.

• Responsible for entire pipeline of charge capture activities from encounter form development and review to correct coding and oversight for ensuring accurate reimbursement for services billed. Responsible for driving process improvement initiatives related to front end revenue cycle functions, in collaboration with the operations leadership and clinic managers.

• Manages the monthly OR reconciliation process to ensure that all procedures/operative cases are billed in a timely manner. Analyzes month end reports presented by billing vendor, identifying opportunities for work process improvements with respect to claims denials. Works with divisional managers on strategies to improve front end related issues.

• Serves as a key resource for changes in payment and coding guidelines from all payers. Educates and reeducates them on these continual updates. Responsible for constant and continual education of the physicians on coding changes.

• Facilitates and influences the credentialing process to assure prompt ability to bill for services rendered by newly hired physicians.

• Analyzes monthly reports, tracking work effort by the billing vendor to ensure collections activity on a regular basis. Analyzes weekly charges and payments data to ensure billing vendor is on track to meet established targets for productivity. Reviews EOBs as needed to determine/address payer problems. Coordinates efforts regarding authorization issues.

• Perform regular updates of the Practice Management System spreadsheet (PMS) for accuracy and completeness. Provide necessary support to the Accounting Department during the month end PMS reconciliation to the accounting software.

• Monitor and maintain all unprocessed and rejected claims from the third party Billing Agency. Analyze claim returns and rejections from the third party Billing Agency to determine the reason for the return/rejection; performing needed corrections as appropriate. Forward information to appropriate clinical/provider staff for prompt correction of returned and rejected claims.

• Serve as a mentor and information resource for the clinical front desk staff by being available by phone and email to answer questions during business hours and by traveling to each clinic site at least once a week to observe and work with front desk on any ongoing training needs.

• All other duties and projects as assigned.

Qualifications:

• Bachelor's Degree in Health Care Administration or Business Administration or related field. Master's Degree Preferred
• Six years' experience working in the healthcare with at least two years of managerial or project leadership experience
• Must be able to demonstrate history of progressive responsibility and leadership skills
• Proven experience creating, analyzing and explaining complex reports
• Demonstrate independent judgment and self-sufficiency in effective problem solving
• Extensive knowledge of HIPAA regulations diagnosis and procedures codes, insurance claim processing, is required; understanding of Fair Debt Collection laws
• Extensive analytical skills and the ability to clearly communicate decisions, procedures and processes to a diverse group of people.
• Perform root cause analysis of issues and implement corrective solutions
• Excellent communication skills, written, verbal, and listening, as well as demonstrated business writing skills, are required.
• Knowledge of Health Information Systems.
• Proficiency with standard office equipment and software such as Microsoft Office, specifically high aptitude in Microsoft Excel, proficiency in Power Point, and knowledge of VISIO
• Must be willing to travel to clinical sites as necessary to accomplish departmental and organizational goals.

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